Provider Demographics
NPI:1417039975
Name:LESLIE, MARISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14915 BROSCHART ROAD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-315-3826
Mailing Address - Fax:301-251-4666
Practice Address - Street 1:14915 BROSCHART RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3350
Practice Address - Country:US
Practice Address - Phone:301-838-4912
Practice Address - Fax:301-251-4666
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4266452084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry